Nerve pain and rheumatism

[MaryM]

I

[Ed R.]

I am a 41yo male active and healthy who came down with an apparent stroke in my peroneal nerve last Sept.which resulted in a left foot drop and severe nerve damage on my left side with mild weakness right foot.   I went through all the nerve conduction tests,ivig treatments, mris, lumbar puncture and finally a nerve and muscle biopsy.  The neurologists are puzzeled by my case and were hoping the biopsy might show vasculitis, but the results where inconclusive.  I was then referred to a vasculitis clinic at JHopkins, he wants to place me on 60mg prednisone for 6-9 months even though there is no sure way to determine if vaculitis is active non-systemic.  I have been reading up on prednisone and cytoxin and it sounds like the worst treatment possible. I am fearful and need to make a decision soon.  Are there any other alternative treatments for vasculitis?  Thanks for hearing me. Ed in MD

[Kevin Pho, MD]

Hello - thanks for your patience.

Radiating pain is suggestive of a nerve, or neuropathic type pain.  The neurologist has already performed comprehensive testing including EMG and MRIs.  She is already on a strong dose of neurontin, which is used to help neuropathic pain.

With the blood test, make sure the following has been tested:  complete blood count, erythrocyte sedimentation rate (ESR), thyroid stimulating hormone (TSH), serum protein electrophoresis (SPEP), blood glucose, vitamin B12 concentration, antinuclear antibody, and urinalysis.

Other tests for nerve pain would be a nerve biopsy - which can be considered by the neurologist.

The only infection that I am aware of that can lead to such pain would be herpes zoster.  Make sure that this has been considered.  

If the neurology workup continues to be negative, you may want to consider a rheumatology referral - although I think that that avenue may be of low yield.  A referral to a pain clinic or physiatrist can be considered to help manage the discomfort.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[kevinmd]

I'll be away until January 4th - I will answer your question when I return.

Happy holidays,
Kevin, M.D.